Although the session was open to all topics, healthcare reform dominates

Arriving more than a half-hour late Tuesday, U.S. Sen. Tom Udall still won some respect from a packed house of about 500 primarily Lincoln County residents for facing their questions about the federal government's proposed healthcare overhaul.

Several in the audience at the Ruidoso Convention Center, weighted heavily with retirees, jabbed at U.S. Rep. Harry Teague's lack of public forums on the subject. Dr. Walter R. Seidel interrupted criticism about the lack of effective control over proposed "reform" of the system to congratulate Udall for scheduling the forum.

"We have a congressman from the area who has no balls," he said of Teague, to loud applause.

Both Udall and Teague are first-term Democrats. Lincoln County is considered by voter registration to be a predominantly conservative Republican refuge in a Democrat-dominated New Mexico.

Before Udall's plane flew into Ruidoso's regional airport, his staff directed people who wanted to ask questions to fill out cards listing their names. Cards were picked randomly and, after Udall's entrance, three sets of five people were allowed to come to the podium to pose their questions.

Toward the end of the hour-long session, Seidel walked to the microphone and said he had patients waiting, but wanted to speak before he left. With concurrence from others in line, the physician, who said he's practiced in Ruidoso 15 years, said,

"All we see is a system that is broken and needs repair. As a physician, I have to identify what is wrong with my patients before I can fix them. Unfortunately, you guys haven't identified the problem and you plan to fix it with more bureaucratic bull----."

He doesn't want government telling him how to take care of his patients, he said. Udall broke in and said if Seidel accepted Medicaid and Medicare patients, he's already being paid with government dollars.

Someone from the audience yelled out, "Yeah, 10 cents on a dollar."

Seidel added, "That's everyone's money - yours, mine, theirs."

The family practitioner said he read the bills around which the reform plan is being built and 90 percent of the rules and methods of operating will be left to the discretion of the Health and Human Services director to develop as policy, he contended, adding, "There is no control."

That was the problem when former President George W. Bush deferred to Treasury Secretary Henry Paulson in the first bailout bill, he said. Now its H&HS Secretary Kathleen Sebelius who will be in control.

"My patients are scared to death," he said. "You haven't read the bill. (Your staff) hasn't read the bill. You say trust the government to fix it, but I don't believe you believe that anymore than I do. The difference is you have to go out and sell this."

First up at the forum, James Grath rolled to the microphone in a wheelchair and asked how Con-gress planned to pay for the health care bill without raising the deficit.

"My first pledge to you is when we do healthcare reform, it will be deficit neutral," Udall said, to skeptical murmurs from the audience. "Or I won't vote for it."

After one woman asked about expanding Medicare-type coverage to younger people, Udall asked for a show of hands of people who are satisfied and dissatisfied with Medicare. The majority indicated they were satisfied.

"One of our big challenges with Medicare, and that's why I think people in the audience are worried on this issue of cost, is if you look 10 years out, the way we are going, Medicare will hit the wall, it's not sustainable," Udall said. "The trustees for Medicare reported to us we need to take a look at revenue sources and take a look at benefits and make the two fit together so that Medicare does not hit the wall and we can continue to provide care. I am committed to that. Congress is committed to that. I'm not sure at this particular point whether it would be wise to expand Medicare into a particular area until we get it on a solid basis. In no way would I want to eliminate it."

Some people, when they talk about health care for all are talking about a single payer plan, the senator said. "Single payer has been really taken off the shelf in Washington," he said to a mixed reaction of applause and some boos.

"That's the reality," Udall said. "We have a president who said we are going to grow on the system we have in place and that is an employer-based system. If we can get Medicare healthy and in 20 to 30 years out, it is doing well, part of our solution might be to allow people from 60 to 65 buy into Medicare. Until we get it healthy, I think it's important we don't add to the burden."

Medicare coverage currently begins at 65.

Udall said that of the 26 percent of New Mexicans uninsured, the majority are working. "If you had a system where health care was affordable for employers, you could include them in the system," he said.

Gene King, retired Air Force with three sons in the military, asked what Congress will do to train and retain more physicians to take care of the numbers added to those receiving health care, when their earning ability is being driven down.

Udall said the shortage of physicians in the state is critical and 75 percent of the graduates from the University of New Mexico School of Medicine leave the state for jobs. The first issue is to keep them here, he said. Studies show if newly educated doctors do their residencies in local hospitals, spend several years and learn to love a community, they end up staying.

"You're right; nationwide, if we bring more into the health care system, we will need more doctors," he said.

Rancher Howard Jolly said he thought President Bush made an honest effort to reform Social Security, also considered in a financial crisis, and in his State of the Union address laid down a challenge for anyone including Congress to come up with a plan to fix it.

"In his next year's State of the Union address, he said not one plan came across his desk and the entire Democratic side of the aisle stood up and cheered," Jolly said. "That is the single most irresponsible thing I've ever seen. Three years later, Social Security isn't fixed, Medicare isn't fixed, Medicaid isn't fixed, and I want to know when we're going to see some fiscal responsibility come out of our government."

He said he is satisfied with his insurance through Presbyterian and doesn't want anything shoved down his throat.

Udall said he hoped he relieved some of Jolly's concerns. "You have a policy and coverage now and you like it," the senator said. "We won't fiddle with it. We will build on the system we have now." Audience reaction was mixed.

Dr. Ken Ogilvie, a retired obstetrician, said he left the state after the Medicaid office ceased to pay his fees from May to October. "I was not paid for any care, period. So the government stole months of my services and I didn't like that," he contended.

Ogilvie claimed he had read the entire 1,000-page House Resolution 3200, aka America's Affordable Health Choices Act of 2009. He said that, based on the cost of health care today and the number of people who would be added, "there's a lot of promises and not enough money."

Udall responded that the current system is unsustainable and one reason is that the insured already pay for the uninsured through premiums, through tax support of the hospital and tax support of a medical indigent fund.

"We try to lessen the burden on those who have care now and take care of the whole issue of the uninsured by getting them to put money into the system," he said.

Sally Moore of Capitan asked Udall, "If the bill is so convoluted and confusing, why can't it be dismantled into several bills?"

Udall said there already are several bills, including HR3200 in the Senate, a bill through the Health Committee with U.S. Sen. Jeff Bingaman (D-NM) and one the Senate Finance Committee is working on to be produced in September.

To another questioner, Udall said he supports a public option. "I believe a public option keeps insurance companies honest," he said.

Resident John Finley said that in reading the bill, he saw no mention of tort reform, saying doctors are practicing defensive medicine and that drives up the cost of care. When the applause died down, Udall, an attorney, responded that tort reform should be on the table.

"The thing you should be the proudest of is New Mexico is a leader on tort reform," he said. "We have a cap on damages. We have an incredible reform [that] I think ought to be done at the national level. If you are going to accuse a doctor of malpractice, you first must go to a medical-legal panel with doctors, lawyers and citizens. You cannot file a lawsuit in court until you go and they rule if there is liability or no liability and because of that many frivolous lawsuits are dropped. Tort reform should be on the table."

DeWitt Welch, who said he was retired Army, referred to a comment by a politician after leaving a fundraiser in Albuquerque that, the "real decision will be made in Washington D.C.," not at town hall meetings.

"Is this just going to be lip service made to the public to have these town hall meetings or are you listening and do what they want?" he asked. "After all, you have taken the same oath I have, and I've taken it more times than President Obama (to uphold the Constitution).

"Are people actually going to have a say-so in this or is Congress going to ram this down our throats? The Democratic majority seem to think they can push it with 51 votes."

Udall said he's conducted forums throughout his political career - 15 this calendar year including Tuesday's - and tried to bring his elected offices to the people. Town hall meetings are important to gauge what's going on, he said.

"I'm going to listen to my constituents," Udall said. "I don't think this will be a ramrod job in Washington." When some people began to laugh. He pointed out there's an obvious division of opinion in the room, but with discussion, it may be possible to find common ground.

A representative of a machinists union in southern New Mexico said something must be done about the rising cost of health care, although the quality is good.

Small business impact

Jerry Tully of the Hondo Valley said he doubted the government can keep 1,500 insurance companies honest. He feared the impact on small businesses, saying a 2 percent to 8 percent tax paid to support healthcare reform would wipe out any profit for his ranch.

"Usually, legislation comes from the people," he said. "It's something they want. This is coming the other way. The majority of the American people are against this." Several people booed Tully.

 

In other questions from participants at the meeting, Udall:

 

  • said veterans will not be affected by the healthcare reform bill and that all veterans should have access to good health care, something that did not always occur in the past.

     

  • was noncommittal if he would follow the directive of the people, if a referendum on healthcare reform was introduced and America voted. He said he would like to look at any bill suggesting a referendum, but had not seen one to date.

     

  • said pharmaceutical companies and tricks they use to extend the time period of a patent to prevent a generic version at a lower cost are not covered in HR3200, but "that's a doughnut hole that should be filled." Too often, a company will slightly alter a medicine and add an extra word to the name to extend a patent, he said.

     

  • said if a healthcare plan passes, he and his family will enroll in that plan. He acknowledged the type of plan offered to federal employees would bankrupt a small employer and the country if it was opened to everyone, be-cause a small entity can't get the same price breaks.

     

  • said nothing in the bill says illegal aliens would be covered by a healthcare plan.

     

  • contended the Senate dropped a provision requiring end-of-life counseling, but acknowledged it re-mains in the House version. He spoke of his mother's death from cancer and said end-of-life choices should be left to families and the individuals.

    As the session wound down, Udall thanked the crowd for coming, saying, "In our democracy, I think the most important thing is to have educated citizens to get involved and engaged."